Obama's zero-sum game in the fight against AIDS

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By Gregg Gonsalves
Thursday, January 13, 2011; 8:00 PM

Since the November elections and after his compromise over the extension of the Bush-era tax cuts, some Democrats have suggested that President Obama doesn't have the guts to go mano a mano with the Republicans. Others have intimated that if Obama can't stand up for what they see as traditional Democratic values, perhaps the party needs to find another champion in 2012.

As a loyal Democrat, I find that remarkable. As an AIDS activist, I find the proposition hard to believe for a personal reason, one that some may find surprising. I know that the president is willing to engage in political combat: He has castigated us at every turn for criticizing his policies on global health and HIV/AIDS.

I was part of a group of two dozen students from Harvard and Yale universities that interrupted a rally in Bridgeport, Conn., in late October at which the president spoke. When we called on him to honor his campaign promises on AIDS, Obama chastised us, made hyped-up claims about his administration's commitment to fighting the disease and said that the Republicans would cut AIDS funding to shreds.

That's the kind of president I want to see: resolute, uncompromising, telling it like it is. Unfortunately, the president is dead wrong on HIV/AIDS and global health.

In November, we staged a protest at Yale against Ezekiel Emanuel, the brother of former White House chief of staff Rahm Emanuel and architect of the Obama Global Health Initiative. Our complaint: that Obama and Ezekiel Emanuel are pitting AIDS against other diseases by making investments in new areas of global health contingent on flat funding for efforts to fight the HIV epidemic.

World AIDS Day in December was another reminder of our frustrations. Last year, the president asked Congress for a 2.8 percent increase in funding for the President's Emergency Plan for AIDS Relief, the smallest in the program's history and well below the rates of inflation in most of the African countries where the money is spent. Last year's budget request also called for a $50 million cut in the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Obama and Ezekiel Emanuel defend the administration's support for combating global AIDS, but their statements simply don't stand up to scrutiny. What the president is doing has deadly consequences - leaving funding for AIDS programs flat will lead to more deaths and new infections around the world, just as progress is being made in many countries. We know economic times are tough, but the president has advocated for funding his priorities even in the midst of this fiscal crisis.

In the past two years, the president has received pleas from Nobel laureate Archbishop Desmond Tutu, Doctors Without Borders, more than 30 deans of schools of medicine and public health, and other global health experts. The core of their common message: We can build on the successes against AIDS to boost efforts on maternal and child health, neglected diseases and strengthening health systems; there is no need to pit worthy priorities against each other, particularly when a comprehensive approach would cost far less than the bank bailouts and, yes, the estate tax repeal that the president signed into law last month.

The White House is willing to go to the mat - but only to defend its position. Citing a calculation of the cost of AIDS drugs, the age at which treatment is offered and the burden of HIV/AIDS in the countries in question, Ezekiel Emanuel doesn't think treating AIDS in Africa is cost-effective - and the president seems to agree. It doesn't seem to matter that many other analyses support the wisdom of providing these life-saving medicines and that for almost a decade there has been a bipartisan and expert consensus on the need to greatly expand access to AIDS drugs in the developing world.

Emanuel and the president say that they have a broader vision for health and that we're too parochial in our concerns. In fact, AIDS activists have been global health activists all along, with many calling for health-care reform in the United States since the epidemic first appeared and for strengthening primary care in the developing world for more than a decade. What we don't support is this administration's either/or approach to global health. But we don't know how to get the president to stop fighting us and turn his sights on a foe far more formidable than we are: the AIDS epidemic, still out of control, 30 years after it began in 1981.

Gregg Gonsalves is an AIDS activist and a student at Yale College.


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